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Employers with one or more employees must provide worker’s
compensation insurance. Employees who work as an employee or apprentice are
covered under workers’ compensation. Exempt employees include domestic
employees and volunteers for religious organizations, schools and school clubs,
non-profit organizations.

Employers and employees can opt out of workers compensation
by contract and negotiation as long as the Workers Compensation Board Director
approves the agreement and ensure that the agreement provides the required
coverage and benefits.

How to file a Hawaii
Workers Compensation Claim

You should report an illness, accident or injury as soon as
possible after the injury occurs. You can report the date, time and details
about the injury. Your employer then must file Form WC-1 (Employer’s’ Report of
Industrial Injury/Illness) with the Insurer and the Worker’s Compensation
division. The employer must file this report within seven days of notification
of the injury.

If the employer fails to do so, you can contact the Worker’s
Compensation Division directly to file Form WC-5 (Employee’s Claim for Workers’
Compensation Benefits). This form can be
obtained from your employer or the worker’s Compensation Division.

Your doctor who is providing you with medical care must fill
out Form WC-2 (Physicians Report) and forward it to both the Worker’s Compensation
division and the insurance carrier in order for you to begin receiving
benefits.

Common Covered Work
Related Injuries

Covered injuries include injuries caused by an “accident
arising out of and in the course of the employment” or “disease proximately
caused by or resulting from the nature of the employment.” Willful acts by third parties based on the
employee’s position are considered to be accidents arising out of the nature of
employment, but willful acts arising out of personal disputes are not covered.

Injuries that occur on business trips and off-premises on
coffee breaks have been found to be covered under worker’s compensation as long
as the injury occurred during activity that was both reasonable and necessary
during the break.

Claims for mental stress injuries resulting form good faith
disciplinary actions are not covered. Claims are also not covered if the injury
arose out of an employer’s willful attempt to self-injure, or when the employee
was intoxicated. Death by heart attack has generally not been found to be a compensable
injury unless a causal relationship between the work and the heart disease can
be proven.

Workers Compensation
Claim Denials

Common reasons for denial include disputes that the injury
is covered, and insufficient medical evidence of a covered disability. Failure
to file the appropriate forms and paperwork may also result in a denial.

Appealing a Hawaii
Workers Compensation Denial

If your employer denies your workers compensation claim, you
can file Form WC-5 (Employee’s Claim for Workers Compensation Benefits) with
the Workers Compensation Division or the Department of Labor and Industrial
Relations District office closest to your home or work location.

When the Department of Labor receives your form, the
Director of the Disability Compensation Division will review the forms and documentation.
You may be asked to provide additional evidence or submit to additional medical
examinations. The Director will then issue a decision.

If you wish to appeal a decision by the Director of the Disability
Division, you must file written notice with the Hawaii Labor and Industrial Relations
Appeals Board. This board reviews decisions made by the director and holds a
hearing to determine your entitlement to benefits. Prior to the hearing, the
Board may request pretrial and settlement conferences in order to attempt to facilitate
settlement.

If no agreement is reached, a hearing is conducted in which
both sides present evidence and testimony. Finally, a written decision and
order is issued following a hearing.

Hawaii Workers
Compensation Benefits

Benefits include payments for the cost of medical care,
temporary and permanent disability payments for loss of wage, disfigurement
benefits, and death and burial benefits.

Injured workers are entitled to choose their own physician
or specialist in Hawaii. The employee must provide notice of their selection to
an employer, and must notify their employer before changing physicians. You may only change physicians once without
approval. Employees may not refuse medical treatment by a qualified physician,
and if they do so they risk forfeiting the benefit payments for medical care.

Medical and vocational rehabilitation may also be provided.
Medical rehabilitation includes access to physical therapies and other medical
apparatuses designed to assist in coping with the disability or recovering from
the injury. Vocational rehabilitation is rehabilitation designed to restore
work skills lost as a result of the injury, or teach new work skills if the
injury has made it impossible to return to the previous employment.

Temporary disability payments are paid at a rate of 66 and
2/3 percent of the workers average weekly wages.

Permanent disability payments are paid at the rate of 66 and
2/3 percent of the average weekly wages up to a state maximum. Permanent disabilities
include loss of sight, loss of feet or hands, the loss of a foot and hand, a
spinal injury resulting in full or partial paralysis, and a head injury resulting
in insanity. Other permanent disabilities are determined on a case by cases
basis.

Permanent partial disability is also paid if the worker is
able to work but is permanently disabled in some fashion. The rate is calculated
by multiplying the permanent disability payment times a specific number indexed
to the type of permanent disability.

Hiring a Hawaii Workers
Compensation Lawyer

Hiring a worker’s compensation attorney is optional, but may
be advisable. A workers compensation attorney can help you to ensure you are
filing the proper forms and meeting all notification requirements. A workers
compensation attorney can file appeals with the Director of the Disability
Division, and with the Appeals Board. Finally, an attorney can help you to
facilitate settlements with your employer’s workers compensation insurer, and
help you to determine what is the appropriate course of action in your
particular case.